'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GP's audit saves heart patients

GPs have been thrown into further confusion over the use of cox-2 inhibitors after a new study appeared to back their use in osteoarthritis but came under heavy criticism from drug safety experts.

The pharmaceutical company-funded TARGET trial found a cox-2 inhibitor could cut gastrointestinal complications by 80 per cent compared with conventional NSAIDs without significantly increasing cardiovascular events.

But the study, published in The Lancet (August 21), found the reduced risk disappeared in patients who were taking low-dose aspirin, which GPs said cast serious doubt on the usefulness of cox-2s.

An accompanying commen- tary claimed the study had purposely excluded patients with a significant history of coronary heart disease in order to play down the cardiovascular risks.

The trial of 18,300 patients over 50 compared the use of

lumiracoxib, a new cox-2 inhibitor to be available in the UK early next year, to the NSAIDs naproxen and ibuprofen.

Study author Professor Michael Doherty, professor of rheumatology at the University of Nottingham, said the study was the first to show a clear reduction in the incidence of gastrointestinal problems.

But Dr Mark Devlin, a GP in Salcombe, Devon, with a special interest in rheumatology, said: 'If aspirin really cancels out any gastrointestinal benefit you really have to question whether it's worth giving cox-2 inhibitors at all.'

Rheumatology expert Professor Paul Dieppe, professor of health services research at the University of Bristol, strongly criticised the research and warned GPs had 'no chance at all' of picking their way through the conflicting evidence.